Critical Care Newsline — June 11, 2009

Critical Care Newsline, the electronic newsletter from the American Association of Critical-Care Nurses, contains information selected just for you by AACN’s clinical practice experts. In each issue, you’ll find links to resources, research abstracts (individual sites may require registration and a fee to access complete articles) and Web sites that will keep you informed on issues affecting nurses and the nursing profession.

1. EVIDENCE Structuring Pain Management in the ICUCritically ill patients are often in pain because of barriers that prevent adequate pain management processes in the ICU, according to results of a recent study. This problem is all too common in hospitals, despite decades of research, guideline development and intense educational efforts. “By nature of their complex medical conditions, these patients present unique challenges to the delivery of optimal pain treatment,” the study’s authors noted. “Outdated clinical practices and faulty systems, such as a formulary that allows dangerous prescriptions, present additional obstacles. A multidisciplinary and patient-centered continuous quality improvement process is essential to identifying barriers and implementing evidence-based solutions to the problem of undertreated pain in hospital ICUs.” The article addresses barriers common to the ICU setting and presents a number of structured approaches that have been shown to be successful in improving pain treatment in patients who are critically ill. The report is part of a series of five papers developed by critical care experts from AACN, the Critical Care Institute of the ACCP and the American Society of Health-System Pharmacists. The article series reviews the complex nature of pain experienced by a critical care patient and details the benefits of taking a comprehensive approach to pain management—one that combines pharmacotherapy with behavioral, social and communication strategies, interdisciplinary teams and family involvement.

2. RESOURCE Implementing Evidence-Based Clinical Practice GuidelinesClinical practice guidelines are more likely to lead to quality care when they are evidence-based and actionable. AHRQ's National Guideline Clearinghouse has more than 2,000 current guidelines that meet specific criteria. The featured innovations and QualityToolssections describe a range of guideline implementation strategies and ways to improve guideline adherence.

3. EVIDENCE Investigational Drug TMC207 Is Viable Addition to MDR TB Treatment (Free Full Text)Patients with multidrug resistant-tuberculosis (MDR TB) improved when the investigational drug TMC207 was added to their treatment, according to a recent study. Researchers evaluated 47 people with multidrug-resistant tuberculosis who received either the usual cocktail of TB drugs and TMC207, or the usual cocktail and a placebo. After eight weeks, 48 percent of those getting TMC207 had negative sputum cultures, compared to 9 percent of those receiving conventional treatment. “TMC207 offers a new mechanism of antituberculosis action by inhibiting mycobacterial ATP synthase,” the study’s authors noted. “TMC207 potently inhibits drug-sensitive and drug-resistant Mycobacterium tuberculosis in vitro and shows bactericidal activity in patients who have drug-susceptible pulmonary tuberculosis.” “The results of this study are highly encouraging."

4. EVIDENCE Global Efforts to Combat Drug Resistant TB (Free Full Text)According to the 13th annual tuberculosis report of the World Health Organization (WHO) — published on World TB Day, March 24, 2009 — there were an estimated 9.27 million new cases of tuberculosis worldwide in 2007. The disease is particularly difficult because treatment is protracted and burdensome. “Recognizing the urgency of this problem,” the reports authors said, “the Stop TB Partnership has defined one of its major objectives as the improvement of laboratory facilities and services and the training of personnel to permit the introduction of new, rapid diagnostic tests for MDR tuberculosis.”

5. EVIDENCE Crowded Emergency Departments Pose Greater Risks for Cardiac PatientsPatients who have heart attacks and other forms of chest pain are three to five times more likely to experience serious complications after hospital admission when they are treated in a crowded emergency department, according to a new study. The authors say that this dramatic difference in rates of serious complications underscores the need for action on the part of hospital administrators, policymakers and emergency physicians to find solutions to what has been termed "a national public health problem." The study followed 4,574 patients who were admitted to the Hospital of the University of Pennsylvania for symptoms of chest pain over an eight-year period. Ultimately, 802 were diagnosed with an acute coronary syndrome; of those, 273 had a true heart attack. There were 251 complications that occurred in the hospital after initial emergency department treatment. When the emergency department was at its highest occupancy and waiting room census, patients with acute coronary syndrome were three times more likely to experience complications in the hospital. When the "patient-hours" was highest, they were more than five times more likely to have a complication. Patients without acute coronary syndrome, but still were sick enough to be admitted to the hospital, also had three to four times more complications at highest waiting room census and patient-hours. The authors were unable to pinpoint the exact causes for why both groups of patients had worse outcomes, but they thought that this might be due to poorer care coordination, delays in testing, and overburdened doctors and nurses in the emergency department and in the hospital.

6. NEWS NTI e-Sampler Is Now OnlineWant to find out more about The National Teaching Institute and Critical Care Exposition? Check out the newly updated NTI 2009 e-Sampler on AACN’s Web page, where you’ll find links to five concurrent sessions (with free CE) along with inspiring, downloadable videos—all videotaped at NTI in New Orleans last month. These select sessions presented by GE Healthcare and AACN will give you just a taste of what it’s like to attend the premier conference and trade show for acute and critical care nurses. Share the following link with your chapter members and colleagues—and plan now to attend the next NTI May 15-20, 2010 in Washington, D.C.

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